1. Probiotic Supplementation in Chronic Kidney Disease: A Double-blind, Randomized, Placebo-controlled Trial 
Natália A. Borges, PhD, Flávia L. Carmo, PhD, Milena B. Stockler-Pinto, PhD, Jessyca S. de Brito, MSc, Carla J. Dolenga, MSc, Dennis C. Ferreira, PhD, Lia S. Nakao, PhD, Alexandre Rosado, PhD, Denis Fouque, MD, PhD, Denise Mafra, PhD 
Journal of Renal Nutrition 
Volume 28, Issue 1, Pages (January 2018)
DOI: /j.jrn
Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions

2. Figure 1 Flow chart of the study subjects.
Journal of Renal Nutrition  , 28-36DOI: ( /j.jrn )
Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions

3. Figure 2
Representation of indoxyl sulfate (IS) plasma concentrations in chronic kidney disease patients on hemodialysis, before (shaded bar) and after (open bar) interventions.
Journal of Renal Nutrition  , 28-36DOI: ( /j.jrn )
Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions

4. Figure 3
Dendrogram by denaturing gradient gel electrophoresis of hemodialysis patients. The samples are grouped according to similarity coefficient (percentage). Each code represents 1 patient before (T1) or after (T2) probiotic or placebo supplementation.
Journal of Renal Nutrition  , 28-36DOI: ( /j.jrn )
Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions

5. Figure 4
Hypothetical effects of probiotic supplementation in chronic kidney disease patients. High urea plasma levels in hemodialysis patients lead to increased urea influx into the colon lumen promoting biochemical alterations in the colonic environment. These conditions may alter the enzymatic activity of bacteria (including probiotics) providing a greater urea hydrolysis rate and large amounts of ammonia. Part of the ammonia may be absorbed reaching the intrahepatic portal circulation and enter the urea cycle which produces urea. Another part of the ammonia may be converted to ammonium hydroxide, a caustic product for intestinal barrier components. The damage to the intestinal barrier could affect the gastrointestinal excretion of potassium and turn the membrane permeable to the diffusion of substances from the intestinal lumen into the bloodstream, such as IS.
Journal of Renal Nutrition  , 28-36DOI: ( /j.jrn )
Copyright © 2017 National Kidney Foundation, Inc. Terms and Conditions